Breast Biopsy (Ultrasound-Guided) — Dictation, Appropriateness, and Dose for Residents
Your next patient is in the breast center for a biopsy of a new BI-RADS 4 mass. The schedule is packed, the attending is double-booked, and it’s on you to get the consent, perform a clean, efficient procedure, and dictate a report that needs zero edits. It’s a bread-and-butter procedure, but the details matter — from the needle path to the post-procedure mammogram documentation. Getting it right the first time is the goal.
As a resident or fellow, mastering procedures like this is key. This guide breaks down the US-guided breast core biopsy into a structured template and high-yield clinical pearls. For more trainee-focused guides and tools, check out the residents and fellows resource hub.
What an Ultrasound-Guided Breast Core Biopsy Covers and What Attendings Look For
An ultrasound-guided breast core biopsy is the workhorse for sampling any suspicious lesion visible with sonography. It’s fast, accurate, and avoids radiation for the procedure itself. It’s the standard of care for most BI-RADS 4 and 5 solid masses, suspicious lymph nodes, or any palpable abnormality with a sonographic correlate.
Your attending expects a report that is concise yet complete, covering the entire procedural workflow. They’re looking for confirmation of:
- Correct patient, site, and target lesion.
- A clear description of the anesthetic and sterile technique.
- The type and gauge of the biopsy device used.
- The number of core samples obtained.
- Successful deployment of a biopsy marker clip.
- Confirmation of clip placement on a post-procedure mammogram.
- Any immediate complications (e.g., hematoma) and how they were managed.
- The plan for specimen handling (e.g., sent to pathology in formalin).
The goal is to provide a histologic diagnosis, determine concordance with the imaging findings, and, if malignant, provide tissue for hormone receptor and HER2 status testing.
Radiology Report Template for Ultrasound-Guided Breast Core Biopsy
This is a solid starting point for your dictation macro. Adapt the bracketed text for your specific case. Remember, a clean, structured report makes everyone’s life easier — from the surgeon to the pathologist.
Technique
PROCEDURE: Ultrasound-guided core needle biopsy of the [right/left] breast.
INDICATION: [e.g., BI-RADS 4B suspicious 8 mm mass at the 2 o’clock position of the left breast, 4 cm from the nipple.]
CONSENT: After a discussion of risks, benefits, and alternatives, written informed consent was obtained from the patient.
TECHNIQUE: The patient was positioned in the [supine/oblique] position. A preliminary ultrasound of the [right/left] breast was performed to confirm the location of the target lesion. The skin was prepped and draped in the usual sterile fashion. Local anesthesia was administered with [10] mL of [1%] lidocaine with epinephrine.
Under real-time ultrasound guidance, a [14]-gauge core biopsy needle was advanced into the lesion. A total of [5] core biopsy samples were obtained and placed in formalin. A [specify type, e.g., UltraClip Dual Trigger] biopsy marker clip was deployed into the biopsy cavity. The final position of the clip was confirmed sonographically.
The patient tolerated the procedure well. Direct manual pressure was applied for hemostasis. Post-procedure mammographic images in CC and MLO projections were obtained to document the final clip position.
Findings
The target lesion is a [e.g., hypoechoic, irregular mass with angular margins] at the [2] o’clock position of the [left] breast, measuring [8 x 6 x 7] mm. The biopsy marker clip is visualized within the biopsy cavity, corresponding to the location of the sonographically targeted lesion.
No immediate complications such as significant hematoma were noted. Post-procedure mammogram confirms the clip is located at the site of the biopsied mass.
Impression
Successful ultrasound-guided core needle biopsy of a suspicious mass in the [right/left] breast with marker clip placement, as described above.
The tissue samples have been sent to pathology for histologic analysis. Correlation with pathology results is recommended for concordance.
BI-RADS CATEGORY: Category 4 – Suspicious
Free Template Sources for Radiology Residents
Building your own template library is a rite of passage. But you don’t have to start from scratch. Two great free repositories exist that are curated by and for radiologists:
- RadReport.org: Maintained by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty.
- Radiology Templates (AU): An excellent, user-friendly site maintained by Australian radiologists with a clean interface and practical, well-structured templates.
Bookmark these. They’re invaluable when you’re on a new rotation or encounter a study you haven’t dictated in months.
The Next-Level Move: AI-Assisted Structured Reporting
The reality of call is that you often dictate the positive findings in a rush just to get the critical information out. You might say, “US-guided biopsy of the 2 o’clock left breast mass, 14-gauge needle, got 5 cores, clip is in, patient did fine.” Cleaning that up into a formal, structured report for the final sign-out takes extra time you don’t always have.
This is where AI-powered dictation tools can streamline your workflow. Instead of just transcribing your words, tools like GigHz Precision AI are designed to understand clinical intent. You can dictate your positive findings in free form, and the AI assistant generates a complete, structured report using pre-loaded ACR and SIR templates. It helps ensure all the key elements your attending expects are included without you having to manually check every box. This approach supports a more natural dictation style while still producing the high-quality, structured output that modern radiology demands.
When is an Ultrasound-Guided Breast Core Biopsy Appropriate? ACR Criteria
The decision to biopsy is guided by the BI-RADS assessment. According to the American College of Radiology (ACR) Appropriateness Criteria for Breast Cancer Screening, an ultrasound-guided biopsy is the go-to procedure for nearly any suspicious lesion that is visible sonographically.
Specifically, it is “Usually Appropriate” for evaluating BI-RADS 4 and 5 lesions identified on ultrasound. The key is sonographic visibility. If a lesion is only seen on another modality, that modality should guide the biopsy. The main alternatives include:
- Stereotactic Biopsy: This is the appropriate choice for suspicious findings, like microcalcifications, that are visible only on mammography.
- MR-guided Biopsy: This is reserved for suspicious lesions that are only visible on a breast MRI.
- Surgical Excisional Biopsy: This is typically performed after a core biopsy yields a high-risk or discordant result (e.g., benign pathology for a BI-RADS 5 lesion) that requires more tissue for a definitive diagnosis.
In short, if you can see it well on ultrasound, an ultrasound-guided biopsy is almost always the right first step for tissue diagnosis.
How Much Radiation Does an Ultrasound-Guided Breast Core Biopsy Deliver?
The biopsy procedure itself uses ultrasound, which involves no ionizing radiation. The estimated effective radiation dose for the biopsy is 0 mSv.
A small amount of radiation is used for the post-procedure mammogram, which is essential for documenting the marker clip’s location. This two-view mammogram (CC and MLO/LM) delivers an effective dose of approximately 0.4 mSv. To put that in perspective, this is equivalent to about 7 weeks of natural background radiation in the United States and is considered a very low dose.
| Procedure Component | Effective Dose (mSv) | Comparison |
|---|---|---|
| Ultrasound-Guided Biopsy | 0 | No ionizing radiation |
| Post-Biopsy Mammogram (2 views) | ~0.4 mSv | ~7 weeks of natural background radiation |
Ultrasound-Guided Breast Core Biopsy Protocol — Key Steps and Parameters
A successful biopsy relies on meticulous technique. The core principle is to plan a needle trajectory that is parallel to the chest wall, which minimizes the already-rare risk of pneumothorax. Always visualize the needle tip entering the lesion *before* firing the device.
The following table outlines the key technical parameters and steps involved in a standard procedure. While specifics may vary by institution, these represent common best practices.
| Parameter | Specification |
|---|---|
| Transducer | High-frequency linear array (12-18 MHz) |
| Patient Positioning | Supine or contralateral oblique to bring lateral lesions medial |
| Needle Approach | Parallel to the chest wall to avoid pneumothorax |
| Local Anesthetic | 5-10 mL of 1-2% lidocaine (with or without epinephrine) |
| Biopsy Device | 14-gauge spring-loaded core biopsy needle |
| Number of Samples | 3-5 cores minimum; some centers obtain 6+ for high-suspicion masses |
| Marker Clip | Required; placed in the biopsy cavity for future localization |
| Post-Procedure | 5-10 minutes of manual compression; 2-view mammogram to document clip location |
Common Protocol Pitfalls: The choice of needle gauge is a balance. While smaller gauges might seem safer, a 14-gauge needle provides a superior tissue sample, which is critical for accurate pathologic diagnosis and reduces the risk of sampling error. Using a smaller gauge can lead to insufficient tissue and a non-diagnostic or discordant result, potentially requiring a repeat biopsy.
3+ months free for radiology residents and fellows
Look like a rockstar on your reports. With the GigHz Radiology Report Assistant, you can dictate your positive findings in free form, and the AI generates a complete, structured report using ACR and SIR templates, with the appropriate Clinical Decision Support (CDS) firing automatically.
We’re offering an extended free trial for all radiology trainees. All we ask is your feedback so we can keep improving the product for residents and fellows on the front lines.
To apply, just let us know these three things:
- Your PGY year (e.g., PGY-2, PGY-4)
- Your training type (radiology residency or specific fellowship)
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There’s no credit card required and no complex forms. Just simple, high-yield reporting that helps you learn the standards and impress your attendings. To get started, apply for the residents free-access program.
Free GigHz Tools That Pair With This Article
Three free tools that complement the material above:
- ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
- GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
- GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.
Frequently Asked Questions
Is the GigHz Radiology Report Assistant HIPAA-compliant?
Yes. The platform is designed for de-identified workflows by default. It processes the clinical content of your dictation to structure the report without requiring or storing patient-identifying information (PHI).
Do I need my hospital’s IT department to set it up?
No. It’s a secure, browser-based tool. There’s no software to install on hospital machines. It works on the computer in the reading room, your personal laptop, or even a call-room iPad.
How does this work with PowerScribe or other dictation systems?
It works alongside your existing system. You can dictate into the GigHz assistant, let it generate the structured report, and then copy-paste the final, clean text into your hospital’s PACS/RIS. It’s an extra step, but one that aims to save time on report cleanup and formatting.
Can I use it on my phone or iPad?
Yes, the platform is fully responsive and designed to work on any device with a modern web browser, making it useful for checking templates or drafting reports on the go.
Can I customize the templates?
Yes. While the system comes pre-loaded with ACR and SIR standard templates, you can create, save, and modify your own templates to match your institution’s or your personal preferences.
What happens after I finish my residency or fellowship?
The extended free access is specifically for trainees. After you graduate, you can transition to a standard plan. We aim to keep pricing straightforward and affordable for early-career radiologists.
Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026
